Urinary Outflow Research Articles

Massive fecaloma causing bilateral hydronephrosis and acute kidney injury: a case report and review of the literature

Introduction and importance: Postrenal acute kidney injury is caused by urinary outflow obstruction either by urethral obstruction or bilateral ureteral obstruction. Fecal impaction was rarely reported to cause hydronephrosis or acute kidney injury. Case presentation: A 76-year-old woman presented with abdominal pain, severe constipation, and lethargy. CT scan showed a massive rectosigmoid fecaloma with changes consistent with stercoral colitis with bilateral hydroureteronephrosis due to the mass effect from the large fecaloma on the distal ureters. Creatinine had climbed to 1.7 mg/dL with electrolyte disturbances. On the sixth day of hospitalization the patient had perforation of the left colon requiring Hartmann’s procedure. The hydronephrosis resolved after surgery with complete recovery from acute kidney injury as creatinine went back to baseline of 0.46 mg/dL. Clinical discussion: The literature described a few cases of fecalomas causing hydronephrosis due to compression of the urinary tract. The presence of a urinary tract infection in the presence of ureteral obstruction poses a risk of developing obstructive pyelonephritis thereby requiring urgent treatment of the cause. Conclusion: Most fecalomas can be cleared using conservative measures. However, recognition of the need of surgical intervention in timely manner is paramount to avoid complications including acute kidney injury and bowel perforation

The Macedo ileum-based reservoir for the management of bladder involvement in epidermolysis bullosa.

Epidermolysis bullosa (EB) can severely affect the urinary tract, leading to strictures and urine outflow obstruction, which pose significant risks to kidney function. Procedures involving the urinary mucosa often exacerbate these issues, making safe bladder emptying a major challenge. This study reviews surgical methods for managing urological complications in EB patients, with a focus on the Macedo procedure, which offers a promising alternative that avoids further bladder mucosa irritation and prevents disease exacerbation. We conducted a systematic review of urological surgeries in EB patients using PubMed, Web of Science, and Google Scholar, adhering to PRISMA guidelines. We propose the Macedo procedure as a novel, safe, and effective technique for managing these patients' urological issues. The review revealed that most existing urological procedures for EB-related urethral obstruction often result in suboptimal outcomes, leading to permanent suprapubic catheters or vesicostomies. The Macedo ileum-based reservoir, with its continent stoma, significantly enhances the quality of life. By ensuring that catheters contact only the ileal mucosa, the procedure prevents exacerbation of EB lesions while maintaining efficient urine outflow and bladder drainage. We applied this technique to our EB patient with complete urethral obstruction following unsuccessful urethral dilations and a vesicostomy. The Macedo reservoir with a continent catheterizable stoma markedly improved the patient's quality of life, with promising initial outcomes despite limited follow-up. The Macedo procedure represents a valuable surgical option for catheterization in EB patients, reducing urothelial irritation and preventing disease progression, and has the potential to improve patients' quality of life.

Short- and Medium-Term Outcomes Assessment of Urethral Prostatic Lift (UroLift) as a Minimally Invasive Treatment for Benign Prostatic Hyperplasia in a Tertiary Care Centre.

Benign prostatic hyperplasia (BPH) is the enlargement and overgrowth of the prostate leading to the compression of the urethra and resulting in obstruction to the outflow of urine. Prostatic urethral lift (UroLift) is a budding minimally invasive technique that utilises mechanical manipulation of the prostate tissue so that the urethra is free from compression, thereby creating a channel for the outflow of urine. The aim of the audit was to assess the short-to medium-term outcomes in our centre in terms of improvement in symptoms, quality of life (QoL) and complication rates. A retrospective observational study was employed. All patients who had UroLift procedure between December 2021 and December 2022 were included. Sixty-four patients were found for the chosen period. Age ranged between 48 and 91 with a mean age of 73. The average prostate size was 48.63 g (31-50 g). Of the patients,64% (n=41) had the procedure performed under general anaesthesia, whilst the rest had either regional or local anaesthesia or entonox. Two to eight clips were used per patient, with four being the median number of clips. Furthermore, 53.13% (n=34) had a catheter post-procedure, with 52.94% (n=18) of these achieving trial without catheter (TWOC) in less than seven days. Of the patients, 67.18% (n=43) had no complications, 7.8% (n=5) went into acute urinary retention requiring short-term catheterisation, 1.56% (n=1) had bleeding requiring blood transfusion and 6.25% (n=4) had infection. Overall, 17.18% (n=11) had failure of procedure requiring other forms of intervention for BPH at two years post-operatively. The median improvement in post-void residual scan and quality of life (QoL) scores were 58 mL and 1.5, respectively. Although transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for BPH, UroLift offers a less minimally invasive approach with better short-term recovery, preservation of sexual function and low complication profile. The failure rate from UroLift from previous studies falls within the range of 7%-22%, and the figures attained in our centre are comparable to these.

Endoscopic treatment of obstructive ectopic ureterocele complexed with concomitant urolithiasis

Ectopic ureterocele is a rare anomaly of the upper urinary tract, often accompanied by the growth of secondary stones caused by impaired urinary outflow. The article presents a clinical case, which shows the peculiarities of diagnosis and possibilities of surgery of this condition, including minimally invasive endoscopic interventions. Emphasis is placed on the consideration of different surgical approaches and their effectiveness in improving the quality of life of patients. Comparative analysis of different techniques shows that endoscopic correction, despite some limitations, remains the preferred option due to the low incidence of complications and rapid rehabilitation.

Comparative Analysis of Surgical Methods for Distal, Mid-, and Proximal Shaft Hypospadias in Young Males: A Prospective Study on Postoperative Outcomes.

Background and Objectives: The purpose of this study is to report on the results of hypospadias surgery in boys using newly developed methods compared with traditional methods of urethroplasty. Materials and Methods: A total of 136 patients were divided into two groups. Fifty patients with coronal, subcoronal, and distal penile types of hypospadias were allocated to Group I. These patients were treated with a new method of SMU I and urethroplasty according to the Snodgrass procedure and MAGPI. Group II consisted of 86 patients with mid- and proximal shaft penile types of hypospadias who underwent urethroplasty using the new SMU II method and urethroplasty according to the Snodgraft and Bracka procedures. The outcomes were assessed according to the level of postoperative wound healing and the presence of complications. Results: The mean age of the patients was 41 to 60 months. After urethroplasty using the SMU I and SMU II methods, recovery was noted in 92.9% of the patients, and repeated surgery was performed in 7.1%. In the patients undergoing operations utilizing the SMU I and SMU II methods, neomeatus dystopia was not detected and postoperative fistulas were observed in 16.7% of incidence. With the standard urethroplasty method, the rate of complications was higher (p < 0.05). Even though the duration of surgery in the group undergoing a procedure using the standard urethroplasty method was lower (p < 0.001), the frequency of primary wound healing was higher in the SMU I and SMU II groups (p < 0.001). Conclusions: The proposed new methods of distal and shaft hypospadias surgery, in comparison with traditional surgical techniques, have the following advantages: good cosmetic appearance of the penis, complete straightening of the shaft, and right outflow of urine through the slit-like neomeatus at the apex of the glans penis.

Use of the subcutaneous ureteral bypass device and urethral stenting for treatment of malignant urinary outflow tract obstructions in cats.

The aim of this study was to describe the technical success and outcomes of ureteral and urethral decompression using the subcutaneous ureteral bypass (SUB) device and transurethral self-expanding metallic stents (SEMS) as a palliative treatment option for feline malignant urinary outflow tract obstructions. A retrospective study was conducted of 14 cats with ureteral and/or urethral obstructions secondary to diagnosed or suspected transitional cell carcinoma (TCC). In all cats, a SUB device and/or a SEMS was placed to relieve the obstruction(s). Group 1 consisted of cats with ureteral obstructions, with or without concurrent urethral obstructions, and group 2 consisted of cats with only urethral obstructions. Eight cats were included in group 1 (seven with concurrent urethral obstructions) and six cats were included in group 2. TCC was confirmed in 8/14 cats. Repeat urethral obstruction due to tumor in growth occurred in 6/13 (46%) cats with a SEMS, and no cats developed recurrent ureteral obstructions after placement of the SUB device. Three cats had additional covered stents placed after urethral re-obstruction. The median survival time (MST) from the time of device placement was 52 days in group 1 (mean 92; range 14-349) and 80 days in group 2 (mean 96; range 7-209). The MST from the time of mass identification of the cats that did and did not receive adjunctive therapy was 349 days (mean 358; range 124-602) and 43 days (mean 113; range 14-423), respectively. The use of bypass devices for feline malignant urinary outflow tract obstructions is a viable option to provide immediate renal and urinary bladder decompression. TCC in cats is locally aggressive and can result in urethral re-obstruction, prompting consideration for placing a covered urethral stent. The use of adjunctive therapies for malignant neoplasia should be considered to improve overall survival once the obstruction has been relieved.

GPER expression prevents estrogen-induced urinary retention in obese mice

Long-term administration of exogenous estrogen is known to cause urinary retention and marked, often fatal, bladder distention in both male and female mice. Estrogen-treated mice have increased bladder pressure and decreased urine flow, suggesting that urinary retention in estrogen-treated mice is due to infravesicular obstruction to urine outflow. Thus, the condition is commonly referred to as bladder outlet obstruction (BOO). Obesity can also lead to urinary retention. As the effects of estrogen are mediated by multiple receptors, including estrogen receptors ERα and ERβ and the G protein-coupled estrogen receptor (GPER), we sought to determine whether GPER plays a role in estrogen-induced BOO, particularly in the context of obesity. Wild type and GPER knockout (KO) mice fed a high-fat diet were ovariectomized or left ovary-intact (sham surgery) and supplemented with slow-release estrogen or vehicle-only pellets. Supplementing both GPER KO and wild type obese mice with estrogen for 8 weeks resulted in weight loss, splenic enlargement, and thymic atrophy, as expected. However, estrogen-treated obese GPER KO mice developed abdominal distension, debilitation, and ulceration of the skin surrounding the urogenital opening. At necropsy, these mice had prominently distended bladders and hydronephrosis. In contrast, estrogen-treated obese wild type mice only rarely displayed these signs. Our results suggest that, under conditions of obesity, estrogen induces BOO as a result of ERα-driven pathways and that GPER expression is protective against BOO.

Revolutionizing Bladder Health: Artificial-Intelligence-Powered Automatic Measurement of Bladder Volume Using Two-Dimensional Ultrasound.

Measuring elevated post-void residual volume is important for diagnosing urinary outflow tract obstruction and cauda equina syndrome. Catheter placement is exact but painful, invasive, and may cause infection, whereas an ultrasound is accurate, painless, and safe. The purpose of this single-center study is to evaluate the accuracy of a module for artificial-intelligence (AI)-based fully automated bladder volume (BV) prospective measurement using two-dimensional ultrasound images, as compared with manual measurement by expert sonographers. Pairs of transverse and longitudinal bladder images were obtained from patients evaluated in an urgent care clinic. The scans were prospectively analyzed by the automated module using the prolate ellipsoid method. The same examinations were manually measured by a blinded expert sonographer. The two methods were compared using the Pearson correlation, kappa coefficients, and the Bland-Altman method. A total of 111 pairs of transverse and longitudinal views were included. A very strong correlation was found between the manual BV measurements and the AI-based module with r = 0.97 [95% CI: 0.96-0.98]. The specificity and sensitivity for the diagnosis of an elevated post-void residual volume using a threshold ≥200 mL were 1.00 and 0.82, respectively. An almost-perfect agreement between manual and automated methods was obtained (kappa = 0.85). Perfect reproducibility was found for both inter- and intra-observer agreements. This AI-based module provides an accurate automated measurement of the BV based on ultrasound images. This novel method demonstrates a very strong correlation with the gold standard, making it a potentially valuable decision-support tool for non-experts in acute settings.

Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury.

Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%-10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction. The aim of the present article is to review and synthesize available evidence on obstructive uropathy, providing a clinical guideline for clinicians. A literature review on obstructive uropathy in the context of AKI was performed, focusing on the least clarified aspects regarding diagnosis and management. Recent literature searching was conducted in English and top-level evidence articles including systematic reviews, metanalyses and large series were prioritized. Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney. Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection. A multidisciplinary approach, including urologists, nephrologists, and other medical specialties, is best suited to correctly manage concomitant hemodynamic changes, fluid and electrolyte imbalances, and other related issues. Obstructive uropathy is one of the leading causes of AKI. Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challenging. A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.

A Case of Urethral Foreign Body from 40 Years Ago with Scrotum Abscess and Urethroscrotal Fistula

A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.

A clinical case of an atypical clinical pattern of renal colic in a nonverbal patient

Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».

(346) Simultaneous Bladder Drainage via Suprapubic and Urethral Catheters: Which Drains More Completely and Why?

Abstract Introduction Reconstructive urologists often place both a urethral and suprapubic catheter intraoperatively to prevent extravasation of undrained urine across anastomosis sutures. As no consensus exists on which catheter drains the bladder more completely, many surgeons leave one catheter to gravity drainage and cap the other postoperatively. Objective We sought to identify differences in catheter urine outflow during dual bladder drainage with suprapubic and urethral catheters in postoperative urology patients. Methods Urine output (UOP) from transgender men who underwent Stage II Phalloplasty with urethral lengthening was retrospectively reviewed. Both 16 French urethral and suprapubic catheters were placed to gravity drainage postoperatively. UOP from each catheter was recorded separately, twice daily. Mixed model regression modeling tested for differences in urine output by time of day (day/night) and activity status (Bedrest: Postop Day 0-2, Ambulatory: Postop Day 3+). Results The aggregate number of 12-hour shift UOP observations was 250 (125 for urethral and 125 for suprapubic catheters) across 14 inpatients. Suprapubic catheters had a mean 410 ml higher output than urethral catheters per 12-hour shift (p=0.002; 95% CI: 185, 636 ml). During daytime, suprapubic catheters demonstrated higher UOP than urethral catheters per 12-hour shift (Estimated Difference: 464 ml; p=0.002; 95% CI: 211, 718 ml). During nighttime, a similar phenomenon was observed (Estimated Difference: 356 ml; p=0.009; 95% CI: 104, 606 ml). When comparing mean UOP from each catheter during the Bedrest Phase, suprapubic catheters averaged an estimated 295 ml higher UOP compared to urethral catheters per 12-hour shift with a trend toward statistical significance (p=0.052; 95% CI -3, 594 ml). During the Ambulatory Phase, mean suprapubic catheter UOP was an estimated 472 ml higher than urethral catheters per 12-hour shift (p=0.009; 95% CI 142, 802 ml) (Table 1). Conclusions Simultaneous bladder drainage with urethral and suprapubic catheters shows greater drainage from the suprapubic catheter (35% vs 65%). The difference in urinary drainage is likely explained by the suprapubic catheter tip and drainage inlet residing in a more gravity-dependent location, within the funnel-shaped bladder neck (Figure 1). When using two catheters, both can be placed to gravity to maximize bladder drainage as the suprapubic catheter can drain residual urine not adequately drained by the urethral catheter. Disclosure No.

СРАВНИТЕЛЬНАЯ ЭФФЕКТИВНОСТЬ АМБУЛАТОРНОГО И СТАЦИОНАРНОГО КОНСЕРВАТИВНОГО ЛЕЧЕНИЯ ПРИ УРОЛИТИАЗЕ У КОТОВ

The article presents the results of a study obtained by comparing the therapeutic effectiveness of outpatient and inpatient conservative treatment for urolithiasis in cats. Among diseases of non-infectious etiology in cats, the diagnosis of urolithiasis is approximately 13 to 28% of cases. Urolithiasis is a chronic disease accompanied by the formation of concretions in the organs of the urinary system. Urolithiasis develops with metabolic disorders in the body, which leads to the formation of phosphate, less often oxalate, urate and other stones. Urolithiasis is accompanied in most cases by a violation of the outflow of urine from the bladder, its gradual stretching and rupture of blood vessels. The experiment was conducted on cats diagnosed with moderate urolithiasis, the age of cats is 3-5 years, the average live weight is 4 kg, in the conditions of the Rostov City Hospital of Rostov-on-Don. To determine the effectiveness of the treatment of urolithiasis in cats, the first experimental group was created, where treatment was carried out in a hospital and the second experimental group, treatment was carried out on an outpatient basis. Based on the results obtained, it was found that the therapeutic efficacy in both groups was 100%, but in the first experimental group, improvement was observed already on the 2nd day of treatment, in the second - by the fifth day. The treatment regimen used in a hospital allows you to quickly eliminate intoxication of the body, restore the water-electrolyte balance, hemodynamics in patients with urolithiasis of cats, which contributes to a faster restoration of the walls of the bladder and urethra.

Iron from the gut: the role of divalent metal transporter 1

Mammalian cells contain thousands of metalloproteins and evolved systems to correctly incorporate metal cofactors into their designated sites. Among the transient metals in living cells, iron is the most abundant element that present as an iron sulfur cluster, mono- and dinuclear iron centers or heme for catalytic reactions. Iron homeostasis is tightly regulated by intestinal iron absorption in mammals owing to the lack of an iron excretive transport system, apart from superficial epithelial cell detachment and urinary outflow reabsorptive impairment. In mammals, the central site for iron absorption is in the duodenum, where the divalent metal transporter 1 is essential for iron uptake. The most notable manifestation of mutated divalent metal transporter 1 presents as iron deficiency anemia in humans. In contrast, the mutation of ferroportin, which exports iron, causes iron overload by either gain or loss of function. Furthermore, hepcidin secretion from the liver suppresses iron efflux by internalizing and degrading ferroportin; thus, the hepcidin/ferroportin axis is extensively investigated for its potential as a therapeutic target to treat iron overload. This review focuses on the divalent metal transporter 1-mediated intestinal iron uptake and hepcidin/ferroportin axis that regulate systemic iron homeostasis.

Tube cystostomy is effective for urinary outflow management in dogs with intervertebral disk extrusion and ischemic myelopathy cranial to the L3 spinal cord segment: 61 dogs (2018-2022).

To describe the application and owner experience of tube cystostomy for management of upper motor neuron urinary bladder dysfunction secondary to intervertebral disk extrusion (IVDE) or ischemic myelopathy, and to report complications associated with cystostomy tube management. 61 dogs. Medical records of dogs with IVDE or ischemic myelopathy cranial to the L3 spinal cord segment that underwent tube cystostomy placement via a short, caudal ventral midline celiotomy were reviewed. Days from tube placement to hospital discharge, days from placement to tube removal, and complications were recorded. An owner questionnaire was distributed to ascertain ease of use and perceived time commitment. 58 dogs were diagnosed with IVDE, and 3 dogs were diagnosed with ischemic myelopathy. The modal neurologic grade at cystostomy tube placement was 4 (range, 3 to 5). The median number of days from cystostomy tube placement to hospital discharge was 1 (range, 0 to 3). Follow-up data was available for 56 dogs. The median number of days from cystostomy tube placement until removal was 19 (range, 3 to 74). Fifteen minor and 6 severe postoperative complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Twenty-seven owners responded to the questionnaire and primarily reported that cystostomy tube use was easy (22/27) and perceived time commitment was low or minimal (20/27). Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs recovering from upper motor neuron urinary bladder dysfunction secondary to IVDE or ischemic myelopathy. This technique is simple for owners to use.

Nonneurogenic female bladder outlet obstruction: Conservative and medical management.

In nonneurogenic female bladder outlet obstruction (BOO), management goals include reduction of outlet resistance to increase urinary outflow and improve bladder voiding to prevent or reduce lower and upper urinary tract (LUT and UUT) function deterioration, by correcting the underlying etiology. As significant progress has been achieved in the conservative and pharmacological management of nonneurogenic female BOO, the purpose of this article is to review and summarize the current literature. For this narrative review, a PubMed® search was performed by cross-referencing the keywords "female bladder outlet obstruction," "female voiding dysfunction," "conservative management," "pharmacological management," and "treatment" with various terms related to the management of female BOO. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. This review discusses and summarizes the conservative and pharmacological management of nonneurogenic female BOO based on the most relevant data currently available in the literature. The recent advances in the understanding of underlying mechanisms involved in female BOO allow for more individualized management. Conservative and pharmacological options show interesting outcomes, particularly in the context of a functional cause of BOO. Overall, the level of evidence is still low regarding the use of conservative and pharmacological measures and more long-term data are required.

Idiopathic functional urinary outflow tract obstruction in dogs, a retrospective case series (2010-2021): 31 cases.

Idiopathic functional urinary outflow tract obstruction (iFUOTO) is an uncommon but life-limiting disease whose etiology and clinical course of disease remain poorly understood. Characterize signalment, clinical signs, clinicopathologic findings, treatments, and propose a standardized response score for dogs with iFUOTO. Thirty-one client-owned dogs diagnosed with iFUOTO. Retrospective case series. Medical records from 2010 to 2021 were reviewed and findings recorded. Dogs were categorized based on the presence or absence of overt signs of neurological disease. Response to treatment was scored. Thirty-one dogs were included. All dogs had stranguria and 14 (45%) had overflow urinary incontinence. Mean age of onset for signs was 6.9 years±8 months. Twenty-four dogs (77%) were castrated males, 5 (16%) intact males, and 2 (6%) spayed females. Eight (26%) of dogs had overt neurological deficits. Follow-up data were available for 29 dogs (median 38 days, range: 2-1277). Final outcome scores were not significantly different among dogs with overt signs of neurological disease (median score 2.5; range: 0-3) and those without (median score 1; range; 0-3; P = .35). Treatments included alpha antagonists, skeletal muscle relaxants, parasympathomimetics, anti-inflammatories, castration, temporary placement of a urethral catheter, or a combination of these. Multimodal treatment was frequently prescribed, but a standard outcome score is needed to evaluate the effectiveness of these therapies. Serial neurological examinations and monitoring of the dogs' dysuria are warranted.

Chronic Urinary Outflow Obstruction Resulting from Prostatic Neurofibromatosis

Chronic Urinary Outflow Obstruction Resulting from Prostatic Neurofibromatosis

«Forgotten» encrusted ureteral stents

The article presents a rare clinical observation of patient S., 50 years old, a long-term sufferer of urolithiasis, who was admitted to the urological department of the hospital with a clinical picture of renal colic on the leſt side, exacerbation of chronic pyelonephritis. From the anamnesis: in 2021, internal stenting of both ureters was performed as indicated. Despite detailed recommendations at discharge, the patient did not consult doctors or take any medications until 2023. The examination revealed that the cause of exacerbation of chronic pyelonephritis and impaired urine outflow were encrusted (“forgotten”) stents in both ureters, in the leſt of which there was a concrement obstructing urine outflow. Ureteroscopy on the right side, stent fragments extraction; ureteroscopy on the leſt side, contact lithotripsy, removal of the encrusted ureteral stent; urinary passage and independent urination were restored. Despite technical difficulties during the surgical intervention, the postoperative period proceeded without complications.

Cross-fused dystopia of the right kidney with cystic dysplasia of the non-functioning left kidney associated with an ureterocele

Cross-dystopia is a rare type of congenital anomaly and is characterized by a displacement of the kidney to the opposite side; as a result, they are both located on the same side, and in approximately 85% of such cases, a fusion of the parenchyma of two kidneys can be observed. We have not found reports of cases in which a nonfunctioning orthotopic cystic dysplastic kidney associated with ureterovesical segment pathology (ureterocele) was fused with the lower pole of a cross-dystopian normally formed kidney in the literature. The patient, 8 days old, had a preliminary diagnosis of agenesis of the right kidney, doubling of the left kidney, cystic dysplasia, doubled left kidney with an ureterohydronephrosis in the lower half and ureterocele. To restore the urine outflow and function of the lower half of the presumably doubled left kidney, a cystourethroscopy was performed. In a typical place on the right, there was a correctly formed ureteral orifice, i.e., an ureterocele on the left, which occupies half of the bladder volume. With a holmium laser, an artificial orifice was formed in the ureterocele to restore the urine passage. At 9 months old, tomography urinary tract was performed, which revealed cross-dystopia of the right kidney with a fusion of the lower pole and a cystic dysplastic orthotopic left kidney. Laparoscopic nephroureterectomy of a non-functioning orthotopic kidney was performed.&#x0D; The control examination indicated complete clinical remission and social adaptation of the patient after discharge. Cross-dystopia of the kidney with fusion, cystic dysplastic kidney, and a ureterocele are rare congenital anomalies that require timely examination in a specialized clinic and drawing up an individual treatment plan. The surgical method should focus on a symptomatic urological problem, emphasizing preserving kidney function.